Cold Weather Injuries: Prevention, Identification, and Treatment- Key information from this website has been placed in this slide deck for field use to create annual training and predeployment medical briefings. (Note: When selecting "Open" file, some users may receive a Windows Security pop-up message; please select "Cancel" and the presentation should load.)

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Commanders, leaders and medical advisors should use TB MED 508 Prevention and Management of Cold Weather Injuries to develop their cold weather injury (CWI) prevention program. This technical bulletin provides guidance on all aspects of CWI prevention. A CWI prevention program should be complemented by Army Risk Management doctrine, as detailed in FM 5-19 Composite Risk Management. A variety of resources and training aids are available at the bottom of this page.

Classroom training on cold injuries and avoidance is not sufficient to prepare troops for operating in cold weather.Opportunities to learn through experience in controlled situations are invaluable. Gradually increasing exposure and training time in the cold will give troops the confidence and ability to recognize potential risks early enough to appropriately employ countermeasures with little mission impact from injuries.

To prevent CWIs, Leaders at all levels must ensure that Service Members receive adequate food, water, and rest; that they implement training on wearing the appropriate cold weather gear, and that they avoid the use of alcohol and tobacco. Pre-mission planning, knowing the weather forecast, and application of the Composite Risk Management process are integral to preventing CWI. Soldiers must use the buddy system to monitor health and performance and report to the unit medic/medical officer any signs or symptoms of CWI. Soldiers should not sleep in vehicles that are running due to the risk of carbon monoxide poisoning.

Cold Weather Clothing

It is important to use cold weather clothing properly, maintain adequate hydration and ensure nutritional requirements to ward off cold weather injuries. When wearing clothing in cold weather, remember the acronym C-O-L-D.

COLD WEATHER INJURIES

Cold weather-related injuries include: injuries due to decreased temperature (hypothermia, frostbite, nonfreezing cold injury), injuries due to heaters, carbon monoxide poisoning, and accidents due to impaired physical and/or mental function resulting from cold stress. Cold weather injuries can also occur in warmer ambient temperatures when an individual is wet due to rain or water immersion.

HYPOTHERMIA

Hypothermia is defined as a body core temperature below 95°F/35°C. Hypothermia is usually characterized as mild, moderate, or severe, based on body core temperature. In order to properly diagnose hypothermia, core temperature must be measured rectally with a thermometer with an extended low range scale. Oral and tympanic temperatures will not yield accurate results in a cold environment, even when care is taken to use the best technique.

Cause

Hypothermia occurs when heat loss is greater than heat production. This can occur suddenly, such as during partial or total immersion in cold water, or over hours or days, such as during extended operations or survival situations.

Hypothermia may occur at temperatures above freezing, especially when a person’s skin or clothing is wet.

Symptoms

Vigorous shivering is typically present. Shivering may decrease or cease as core temperature continues to fall.

Onset of hypothermia is typically associated with the so-called “umbles”, the grumbles, mumbles, stumbles and fumbles that increase as cold affects muscle and nerve function.

Prevention

The keys to preventing hypothermia are layering clothing and staying dry. Remember the acronym COLD:

Keep it Clean

AvoidOverheating

Wear itLoose and in Layers

Keep it Dry

Layers can be removed as ambient temperature or physical activity increases, which can reduce sweating and moisture build-up within clothing.

Treatment

The goals for field management of hypothermia are to rescue, examine, insulate, and rapidly transport. If untreated, hypothermia is a true medical emergency and requires evacuation.

Rewarming techniques include: Soldiers generating their own heat via shivering or exercise, insulating against further heat losses, use of heat on the skin and direct delivery of heat to the core. The latter can only be performed in a hospital setting.

The use of heat on the skin (radiant heat, hot water bottles, electric blankets) should only be applied to individuals who have ceased shivering or have a traumatic vasodilation that increases heat loss.Patients must be reassessed frequently to prevent burns.

For most cases, moving the individual to a warmer location, replacing wet clothing and movement/light exercise are sufficient to restore core temperature.

FROSTBITE

Frostbite accounts for the largest number of CWI each year and occurs when tissue temperature falls below ~28-30°F. Frostbite can occur suddenly due to contact to cold metal or super-cooled liquids such as alcohol, fuel or antifreeze or can develop over time due to prolonged cold exposure. Frostbite is most common in exposed skin such as the nose, ears, cheeks, but can also occur in the hands and feet due to reduced skin blood flow.

All Soldiers with a peripheral freezing injury must be suspected of being hypothermic and treated appropriately. During field management, it is more important to prevent hypothermia than to rewarm frostbite rapidly

NON-FREEZING COLD INJURY

The most common non-freezing cold injuries are chilblain and trenchfoot. Trench foot occurs when tissues are exposed to temperatures from 32-60°F for prolonged periods of time (>12 hrs), whereas chilblains, which is a more superficial injury, can occur after just a few hours of exposure. A non-freezing cold injury is classified by the symptoms and stages of recovery.

CHILBLAIN

Chilblain is a non-freezing CWI that can occur after 1-5 hours in cold-wet conditions when skin temperature is > 32°F/0°C. The most commonly affected areas are the dorsal surface of the fingers, but the ears, face, and other exposed skin are also areas of occurrence. There are no lasting effects from chilblains.

Cause

Continuous or repeated exposure of skin to cold/wet weather conditions at temperatures below 50 °F for more than 1-5 hours.

Symptoms

Chilblain lesions are swollen, tender, itchy and painful.

With re-warming, the skin becomes swollen, red (or darkening of the skin in dark-skinned soldiers) and hot to the touch. An itching or burning sensation may continue for several hours after exposure.

Early diagnosis of chilblains becomes evident when symptoms do not resolve with re-warming.

Prevention

Use contact gloves to handle all equipment; never use bare hands.

Use approved gloves to handle all fuel and POL (petroleum, oil, lubricants) products.

In extreme cold environments, do not remove clothing immediately after heavy exertion (PT); wait until you are in a warmer location.

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